On the identification of clinically significant client changes: Reinterpretation of Jacobson's cut scores

Cut points or cut scores play a central role in Jacobson's popular method of identifying clinically significant changes in psychotherapy. When pre- and posttherapy scores of a client are on different sides of one of these cut scores, the change is considered clinically significant, provided that it is also reliable (i.e., not due to measurement errors). This article critically examines the meanings and implications of these cut scores. Contrary to popular beliefs, they are generallynot the test scores for which the probability of belonging to the Functional population is equal to the probability of belonging to the Dysfunctional population. When the Functional population distribution is above that of the Dysfunctional population, persons scoring above these cut scores can, in fact, have much greater probabilities of belonging to the Dysfunctional than to the Functional population. Goals of Jacobson's method can be attained only with Bayesian methods. Bayesian modifications of Jacobson's cut scores are proposed, although their use is limited by the availability of relevant base rates. Bayesian methods (a) can provide information about the probability that an individual belongs to each population, given his (her) score, and (b) are expected to yield total misdiagnosis rates that are many times lower than those of Jacobson's method. Users of Jacobson's method are cautioned against interpreting ratios of likelihoods as if they were ratios of posterior probabilities.     

A Study of low scores in Canadian children and adolescents on the Wechsler Intelligence Scale for Children,Fourth Edition (WISC-IV)

Knowing the prevalence of low neurocognitive scores for the WISC-IV Canadian normative sample (WISC-IV^CDN) is an important supplement for clinical interpretation of test performance. On the WISC-IV^CDN, it is uncommon for children and adolescents to have 4 or more subtest scores or 2 or more Index scores ≤ 9th percentile when all scores on the battery are considered simultaneously. As the level of the child's intelligence increases or the number of years of parental education increases, the prevalence of low scores decreases. These results are consistent with existing studies of the base rates of low scores in children and adolescents on pediatric cognitive batteries, including the WISC-IV American normative sample. Tables provided are ready for clinical use.     

Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity

The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.     

The efficacy of massage on short and long term outcomes in preterm infants

Purpose

Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants.

Methods

A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants’ group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age.

Results

Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups.

Conclusion

Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants.     

Estimating the effect of gang membership on nonviolent and violent delinquency: a counterfactual analysis

This study reconsiders the well‐known link between gang membership and criminal involvement. Recently developed analytical techniques enabled the approximation of an experimental design to determine whether gang members, after being matched with similarly situated nongang members, exhibited greater involvement in nonviolent and violent delinquency. Findings indicated that while gang membership is a function of self‐selection, selection effects alone do not account for the greater involvement in delinquency exhibited by gang members. After propensity score matching was employed, gang members maintained a greater involvement in both nonviolent and violent delinquency when measured cross‐sectionally, but only violent delinquency when measured longitudinally. Additional analyses using inverse probability of treatment weights reaffirmed these conclusions. Aggr. Behav. 36:437–451, 2010. © 2010 Wiley‐Liss, Inc.     

心脏冠状动脉多层CT检查——临床上我们是否应用得当?

心脏冠状动脉多层CT扫描目前在对心脏进行整体扫描进而发现冠状动脉狭窄或冠状动脉钙化方面应用较多,但从经济费用-临床效益比值考虑,是否所有患者均需进行此项检查值得商榷。为降低患者就诊成本,我们认为,对于年轻非糖尿病患者可先根据Framingham冠心病危险量表进行测算患者未来10年出现冠心病的危险度,如果根据此量表计算的患者未来10年出现冠心病的危险度10%的中度以上危险度的患者,才应该给予心脏冠状动脉多层CT扫描检查以了解其是否需要进一步深入治疗。     

Estimation of trade‐off between costs of preprocessing and primary processing

When people engage in a task, they often take preliminary actions (preprocessing) to simplify primary processing. Usually, a trade‐off is made between the costs of preprocessing and primary processing. We conducted three experiments to find out whether people could adaptively estimate the utility of preprocessing depending on the task situation. The result demonstrated that in performing a high‐complexity task, almost all the participants reduced their overall task performance cost by conducting cost‐adaptive preprocessing. However, for a low‐complexity task, participants tended to conduct preprocessing even though this increased overall task performance cost. Based on these results, we discuss human nature from the viewpoint of the influence of cognitive effort.     

Stabilité à long terme des scores du WISC-IV : forces et faiblesses personnelles

Intelligence is considered as a stable trait over time; psychologists make predictions about the future performance of the child from the interpretation of the WISC-IV scores. However, stability at interindividual level does not necessarily imply stability at intra-individual level. By a test-retest procedure, the stability of categories that classify the performances, and the stability of the personal strengths and personal weaknesses are evaluated on a sample of 277 children aged from seven to 12 years. Categorical stability reveals that the classification into seven categories proposed by the designers of the WISC-IV does not allow reliable predictions. The stability of personal strengths and personal weaknesses is unsatisfactory for the different index scores.     

Distance‐Based Measures of Specialization and Balance in Multi‐Criteria: A DEA‐Integrated Method

Decision makers pursuing several distinct goals may differ in their behaviour. Some try to achieve all goals simultaneously, whereas others concentrate on only certain ones and are therefore specialized. We present a new method of measuring the specialization degree with respect to a given standard balanced relation of the goals. The measurement is integrated into data envelopment analysis (DEA) methodology, uses a non‐compensative distance measure, permits optional convex polyhedral cones as predefined balance sets and guarantees feasible solutions. Geometrically, it is based on the angle between the balance cone and the ray through the point of investigation. The proposed models can be used to support and complement the usual effectiveness and efficiency analysis in multi‐criteria decision analysis and DEA. They are motivated and illustrated by a simple numerical example, compared with an alternative method recently published and applied to real data from the literature. Copyright © 2014 John Wiley & Sons, Ltd.